tbuckley/cabot-search huggingface dataset:
P79 A multidisciplinary expert consensus on the assessment of and support for mental health in children and young people living with skin conditions
Authors: Zahra Moledina, Tess McPherson, Jane Ravenscroft, Rukhsana Ali, Susannah Baron
Journal: British Journal of Dermatology (2023)

Abstract Psychological and mental health concerns are common in children and young people (CYP) living with skin conditions and can have a profound impact on wellbeing. However, there is limited guidance on how best to assess and support the mental health of this population, who are at risk of poor health outcomes. The British Society for Paediatric and Adolescent Dermatology (BSPAD) formed a working group to address the mental health needs of CYP with skin conditions, including hair and nails. A systematic review, appraisal of literature and a national survey were carried out, and a multidisciplinary consensus guideline group was convened, comprising dermatologists with expertise in paediatric dermatology and psychodermatology, psychologists, psychiatrists, general practitioners, paediatricians and specialist nurses. Two multidisciplinary virtual panel meetings took place: (i) an initial meeting to discuss the scope, review the current evidence and identify areas for development and (ii) a second meeting to agree the content and wording of the recommendations. The primary objective was to provide consensus-based guidance on the assessment and monitoring of, and support for, mental health in CYP with skin conditions. Secondary objectives were to address important practical clinical questions relating to primary guidance objectives and provide audit and research recommendations. The expert panel achieved consensus on 11 recommendations for health workers managing CYP with skin conditions. A new patient-completed history-taking aid called ‘You and Your Skin’ was developed and is being piloted. The recommendations focus on improved mental health assessments for CYP presenting with a skin condition, with clinical guidance and suggested screening measures included. Information is given regarding accessing psychological support for CYP when required, and recommendations were provided for training in mental health and neurodiversity for staff. The methodology and recommendations will be presented in full. Embedding a psychosocial approach within services treating CYP with skin disease should ensure that CYP with psychological needs are able to be identified, listened to, supported and treated. This is likely to improve health outcomes.
DS14 Same-day surgery promotes sustainability in dermatology
Authors: Marta Costa Blasco, Claire Doyle, Anne Marie Tobin
Journal: British Journal of Dermatology (2023)

Abstract The healthcare sector is responsible for 4.4% of global greenhouse gas (GHG) emissions. To limit global temperature rise by 1.5 °C, as called for in the Paris Agreement, GHG emissions will need to be significantly reduced. As climate change has been labelled the greatest threat to global health in the twenty-first century, all healthcare professionals must attempt to promote sustainable practice where possible. The British Society of Dermatological Surgery sustainability guidelines published in 2022 advocate multiple strategies for improving sustainability in skin cancer surgery, including a reduction of activity via prevention measures, low-carbon alternatives, operational resource use and research and innovation. It is recommended that ‘see-and-treat clinics’ should be offered where staff and facilities are available, as one of several methods to lower the carbon footprint of dermatological surgery. We performed a cross-sectional study in a single tertiary dermatology department, focusing on carbon dioxide (CO2) emissions associated with travel to and from skin surgery appointments from 1 January 2022 to 31 December 2022. Our dermatology department is located in an urban area and also receives referrals from rural locations. The distance from the patient’s home to the hospital was calculated in kilometres using Google Maps. Total CO2 emissions were calculated using an online calculator recommended by the Environmental Protection Agency of Ireland and were reported in metric tonnes of CO2. Fuel consumption was based on the average car with unknown fuel. In total, 2358 procedures were performed on 2184 patients, 54% of whom were male (n = 1180). The total distance travelled by patients was 109 787.94 km, averaging 50.27 km per patient (range 1.3–168). This generated 18.74 metric tonnes of CO2 emissions. Eighteen per cent (n = 389) of patients underwent surgical procedures on the same day as their outpatient clinic. Same-day surgery led to a reduction of 35 275 km, averaging 90.68 km per patient (range 1.3–120). This represented a reduction of 6.02 metric tonnes of CO2 emissions. This is equivalent to the CO2 emitted from six transatlantic flights. In our department, absorbable sutures are used, where possible, to reduce unnecessary travel to our department or to a general practice for suture removal. Results for benign lesions are communicated via letter, to minimize return to the clinic. This study highlights the reduction in CO2 emissions associated with same-day dermatological surgery. The limitations of this study include an assumption of travel to and from hospital appointments by car and of travel from the address stated in patient records. Dermatologists should consider the environmental impact of skin surgery and implement sustainable options when service planning.
P69 Baseline characteristics of patients with physician-diagnosed hidradenitis suppurativa: results from a retrospective observational study using data from the Clinical Practice Research Datalink database
Authors: Kave Shams, Ellie Rashidghamat, Annette Brown, Paula Pamies, John R Ingram
Journal: British Journal of Dermatology (2023)

Abstract Hidradenitis suppurativa (HS) is a difficult-to-treat, painful, chronic inflammatory skin disorder characterized by nodules, abscesses and skin tunnels. Delay in diagnosis increases disease severity and overall disease burden. In England, HS is associated with a high healthcare resource use, with an estimated prevalence of 1.2% in the general UK population (Ingram JR, Jenkins-Jones S, Knipe DW et al. Population-based Clinical Practice Research Datalink study using algorithm modelling to identify the true burden of hidradenitis suppurativa. Br J Dermatol 2018; 178:917–24). Improved understanding of HS patient profiles in England will help optimize patient care and treatment outcomes. This study aimed to characterize the patient profiles, journey, treatment pathways and treatment outcomes of patients with HS in England using data from the Clinical Practice Research Datalink database. Here, we present the baseline characteristics of patients with HS from this database. Overall, 39 860 patients with physician-diagnosed HS were identified from 1 January 2009 to 31 March 2021. The mean (SD) age at diagnosis was 34.49 (13.07) years, and the majority were female (73.8%). Twenty-seven per cent of patients were White, 7.5% were Asian, 5.0% were Black and 27.9% were of mixed race, while 2.1% were from other races and the race was unknown for 30.7%. Overall, 44.6% were current smokers and 12.7% were ex-smokers. Depression (31.7%), anxiety (21.5%) and acne (20.6%) were the most commonly reported comorbidities related to HS. Chronic pulmonary disease was reported in 26.2% of patients; this may, in part, be attributed to relatively high rates of smoking in the HS population. The most frequently prescribed medications prior to HS diagnosis were pain medication, especially ‘non-opioid’ analgesics (21.8%) and opioids (19.8%); oral antibiotics, particularly tetracyclines (15.7%); combined contraceptive pills (7.2%) and metformin (4.8%). Only a few patients (&amp;lt; 0.05%) received a biologic prior to their HS diagnosis for other chronic inflammatory conditions. The various comorbidities, including psychiatric, metabolic, cardiovascular, gynaecological and pulmonary and associated treatments, observed in this real-world study in England suggest that optimal management should involve a multidisciplinary approach to improve outcomes in patients with HS.
P01 Severe adult-onset inflammatory disorder with associated <i>UBA1</i> somatic mutation
Authors: Evangelia Vetsiou, Steve Smith, Karina Forde, Sarah McDonald, Duncan Brian, Andre Khoo
Journal: British Journal of Dermatology (2023)

Abstract A 70-year-old man was admitted to the hospital with a 2-week history of fatigue, florid erythematous maculopapular rash, elevated inflammatory markers and thrombocytopenia. A skin biopsy was performed that showed features in keeping with Sweet syndrome, which was initially thought to relate to concurrent gastrointestinal sepsis. The patient was commenced on oral prednisolone 30 mg daily. His rash and inflammatory markers improved, but his ferritin levels remained elevated. Within 1 month, he presented again with a widespread rash comprising tender and erythematous nodules. Serial computed tomography did not reveal an underlying malignancy. The patient was referred to haematology for consideration of a bone marrow biopsy, which showed hypercellular marrow with active trilineage haematopoiesis, and dysplastic changes in granulocytes and megakaryocytes. Molecular analysis showed a characteristic UBA1 p.(Met41Leu) mutation, which confirmed a diagnosis of VEXAS syndrome. He was considered for treatment with tocilizumab, but his skin symptoms responded well initially to oral steroids and, later, dapsone. He remains asymptomatic on dapsone. VEXAS syndrome is an autoinflammatory condition, first described in 2020, that results in a constellation of inflammatory and haematological manifestations due to a somatic mutation in UBA1 on the X chromosome. It can affect the skin, cartilaginous structures, lungs, joints and vasculature, as well as the haematopoietic cells. Patients with this condition have only been partially responsive to treatment, with high doses of corticosteroids showing the most consistent benefit of all the modalities tried thus far. The prognosis is poor and diagnosis is usually delayed. To date, relatively little is known about the dermatological manifestations of VEXAS syndrome. These are usually characterized by neutrophilic dermatoses or vasculitis. More recent studies have shown that skin involvement is associated with clonal infiltration of the skin rather than a general proinflammatory activation. This suggests that therapies that target the pathological clone, as well as the proinflammatory milieu, such as steroids and Janus kinase inhibitors, may be useful. However, further studies and trials are required to understand how to best cure the disease.
H03 Madam C.J. Walker and her wonderful hair grower
Authors: Claire Doyle
Journal: British Journal of Dermatology (2023)

Abstract Madam C.J. Walker was born Sarah Breedlove in December 1867 in Louisiana, USA. She was the first child in her family born to freedom following the abolition of slavery in the USA in 1865. She was orphaned at the age of 7 years and began working as a domestic servant at the age of 10 years. She married when she was 14 years old and became the sole parent of a 2-year-old daughter following the death of her husband in 1887. Seeking a way out of poverty, in 1889, she moved to St Louis, Missouri, where her four brothers were barbers. During the 1890s, she developed significant hair loss. In an attempt to tackle the said hair loss, she consulted her brothers for advice and experimented with many homemade remedies and store-bought products. In 1906, she married Charles Joseph Walker and became known as Madam C.J. Walker. By this time, she had developed her own formula to heal scalps and spur hair growth specifically for Black women who had been overlooked by the beauty and haircare industries. The initial product was known as ‘Madam Walker’s Wonderful Hair Grower’, which she began selling in 1907. Ingredients included precipitated sulfur, copper sulfate, beeswax, petroleum jelly, coconut oil and a violet extract perfume to cover the sulfur smell. At the time, sulfur was commonly used to treat dandruff. Along with her hair grower, Walker’s early products included Glossine (a pressing oil) and a vegetable shampoo. She urged clients to shampoo more often and to follow her ‘Walker System’, using the hair grower, oil and hot combs to make ‘lacklustre and brittle hair become softer’. Her products became widely used and her strong customer base led her to becoming the USA’s first self-made female millionaire. She died due to kidney failure in 1919. Her company still exists under the name Madam C.J. Walker Beauty Culture. Madam C.J. Walker was not a dermatologist and was not medically trained, but she was one of the first people to pay attention to the issue of hair loss experienced by Black women. Over 100 years later, the field of dermatology is still trying to address the lack of attention and research given to presentations in those with skin of colour.
P102 Severe atopic eczema is associated with reduced acne vulgaris in Bangladeshi children and young adults: a retrospective analysis from a cross-sectional study
Authors: Aaron Hughes, Elsa Barbosa, Jeva Cernova, Bjorn Thomas, Edel O’Toole,, Ryan O'Shaughnessy
Journal: British Journal of Dermatology (2023)

Abstract Atopic eczema (AE) is the most common inflammatory dermatosis, affecting up to 20% of children. Loss of function (LoF) mutations in FLG are the most strongly implicated genetic risk factor for eczema. To understand the effect of FLG on the pathobiology of AE, we knocked down FLG in primary keratinocytes using short hairpin RNA and performed phosphoproteomic analysis, which showed downregulation of the AKT signalling pathway, confirmed using Western blotting to phospho-AKT and immunostaining of biopsies from patients with AE. Given that AKT signalling is increased in acne vulgaris, we hypothesized that loss of FLG may protect patients with AE from acne. The Tower Hamlets Eczema Assessment (THEA) study is a cross-sectional study that aims to phenotype and genotype 1000 Bangladeshi children and young adults with AE. So far, 620 participants have undergone genotyping, 37% of whom have LoF mutations in FLG. We selected patients from this cohort who were older than 12 years of age. In total, 204 patients (99 FLG wild type, 86 heterozygotes, 19 compound heterozygotes) were included. We identified a diagnosis of acne or previous prescription of topical acne therapies or tetracycline antibiotics from the patients’ general practice e-health records. We stratified the patients by genotype, Eczema Area and Severity Index (EASI) score, Patient Oriented Eczema Measure (POEM) score, transepidermal water loss (TEWL) and palmar hyperlinearity groups. The χ2-test was used to determine differences between groups. A lower proportion of patients with AE with FLG mutations had acne (27% wild type vs. 19% FLG mutations), which was more pronounced, but not statistically significant, in the compound heterozygote group (16%). We saw a nonsignificant reduction in acne in patients who had the top 25% of TEWL measurements, those with the most severe form of hyperlinearity and those with higher POEM scores. Patients with severe AE, measured as an EASI score &amp;gt; 21, had a more reduced incidence of acne than those with lower EASI scores (9% vs. 26%; P = 0.04). Overall, this suggests that patients with more severe AE are protected from developing acne. There was insufficient evidence to establish if this was mediated by a reduction in filaggrin (FLG) and AKT signalling. This may be because the groups were too small to determine this. Given that all patients with severe AE have reduced FLG expression regardless of genotype, it is possible that this is mediated through FLG–AKT signalling.
BT08 Mapping UK frameworks for ethical artificial intelligence applied to dermatology
Authors: Syed Fazal Hussein Shah, Rubeta N Matin
Journal: British Journal of Dermatology (2023)

Abstract There is significant enthusiasm to apply artificial intelligence (AI) in dermatology with an emphasis on image-based analyses for risk assessment of suspicious skin lesions. However, the rapid development and deployment of such AI tools raises concerns that ethical issues arising from their widespread, long-term use may not have been adequately considered during design or implementation. Dermatology, in particular, has been identified as lacking sufficient bioethics research that could standardize the approach to regulating AI-assisted applications. Despite significant efforts to develop robust guidelines for ‘ethical AI’ across private, national and international organizations, debate continues surrounding which ethical principles should be included. The 2022 National AI Strategy positions the UK as leading global efforts toward achieving safe and ethical deployment of AI. We sought to systematically review and analyse policy documents to map UK principles for promoting ethical AI as applied to dermatology. Our review identified five UK policy documents relevant to ethical AI published between 2016 and 2022. All included frameworks highlighted the importance of upholding transparency and fairness along the entire lifecycle of AI development and decision-making. The five frameworks also incorporated autonomy through reference to maintaining informed consent, data privacy and human contestability of AI decisions. The principles of accountability and nonmaleficence were each identified in four policy documents, emphasizing the needs for clear definitions of legal and organizational responsibility and for thorough testing of AI tools to avoid unintended/unwanted outcomes. The principles of beneficence (designing AI to promote good on both individual and societal levels) and sustainability (continually monitoring and adjusting AI tools for longevity and efficacy) were each included in two policy documents. Current UK policy frameworks for ethical AI converge around five key values: fairness, transparency, autonomy, nonmaleficence and accountability. The principles of beneficence and sustainability were advanced, although less frequently highlighted. Despite a reassuring level of convergence across policy documents, the practical implementation of these ethical principles in health care and particularly for skin-specific AI tools remains unclear. Furthermore, evidence of real-world integration of these ethical frameworks into developing AI-based skin cancer diagnostic tools is lacking. Future work seeks to address this gap by analysing commercially available skin cancer diagnostic applications using predefined ethical themes to identify case-specific ethical issues and to evaluate the extent to which these issues are addressed within the existing ethical frameworks. This will provide guidance for developers and adopters of these tools, ensuring responsible design and deployment.
DP22 Cutaneous lymphoid hyperplasia: clinicopathological correlation and a therapeutic option
Authors: Jehad Alassaf, Ramzi Alhyari, Hayat Khasawneh, Sanaa Wahidi, Maysoon Al-Ruhaibeh, Salah Abdallat
Journal: British Journal of Dermatology (2023)

Abstract Cutaneous reactive lymphoid hyperplasia, also known as cutaneous pseudolymphoma, is an uncommon entity in which there are skin lesions that histologically, and sometimes clinically, mimic cutaneous lymphoma but are not, both morphologically and immunohistochemically. Correlating clinical, pathological, immunohistochemical and, occasionally, molecular findings is essential for the diagnosis (Romero-Perez D, Blanes Martinez M, Encabo-Duran B. Pseudolinfomas cutaneous. Actas Dermosifiliogr 2016; 107:640–51). Although the majority of cases can be regarded as idiopathic, certain infections and inflammatory conditions can precipitate cutaneous reactive lymphoid hyperplasia, examples of which include Borrelia infection, insect bite reactions and folliculitis (Mitteldorf, C, Kempf, W. Cutaneous pseudolymphoma – a review on the spectrum and a proposal for a new classification. J Cutan Pathol 2020; 47:76–97). The first case was an 18-year-old woman who presented with deep dermal and subcutaneous nodules for the last 5 years that started on her limbs and were slightly itchy. The nodules were firm and deep, with minimal surface changes (hyperpigmentation and adherent scale) but did not ulcerate. She also had nodules involving her buccal mucosa, inner lips and soft tissue in the nasal bridge and a couple of deep nodules on the cheeks. Pathological examination showed a dense lymphocytic infiltrate with plasma cells admixed with other inflammatory cells involving the deep dermis with an extension to the dermal/subcutaneous junction. The pathological picture was in the spectrum of deep tumid lupus/lupus panniculitis overlap and cutaneous lymphoid hyperplasia. Immunohistochemical stains showed a mixture of inflammatory cells with CD3+ and CD20+ cells. Lip mucosal biopsy showed florid reactive lymphoid follicular hyperplasia. Her condition was resistant to multiple systemic treatments. Eventually, she underwent treatment with rituximab and had satisfactory results. The second patient is an elderly female who had multiple erythematous papules, plaques and nodules on her face. Pathological examination showed a dense dermal lymphocytic infiltrate with periadnexal predilection and reactive follicles that also were highlighted by CD20, with Bcl2 and CD3+ cells around germinal centres. She was diagnosed as having cutaneous reactive lymphoid hyperplasia. Topical calcineurin inhibitors were initiated, with a good response. In conclusion, this paper highlights the term cutaneous pseudolymphoma/cutaneous reactive lymphoid hyperplasia, presenting a few cases with clinicopathological correlation and exploring some uncommon treatment options.